552273 research-article2014
JIVXXX10.1177/0886260514552273Journal of Interpersonal ViolencePatterson and Tringali
Article
Understanding How Advocates Can Affect Sexual Assault Victim Engagement in the Criminal Justice Process
Journal of Interpersonal Violence 2015, Vol. 30(12) 1987–1997 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260514552273 jiv.sagepub.com
Debra Patterson, PhD1 and Brenda Tringali, MSW1
Abstract Following a sexual assault, survivors may seek help from multiple community organizations including the criminal justice system (CJS). However, sexual assault survivors often feel apprehensive about participating in the CJS and thus, few report their victimizations to law enforcement. Of those who report, many withdraw their participation from the CJS. Rape crisis center advocates often are one of the first professionals victims encounter while seeking help after a victimization and thus, they may play a key role in reducing barriers to victim participation in the CJS. Qualitative interviews were conducted with forensic nurses and victim advocates at a Midwest Sexual Assault Nurse Examiner (SANE) program to examine how advocacy services may influence victim engagement with the CJS. This study found multiple components of advocacy services that may address common barriers to victim participation. Implications for research and practice are discussed. Keywords sexual assault, rape, victim advocates, criminal justice, Sexual Assault Nurse Examiner programs 1Wayne
State University, Detroit, MI, USA
Corresponding Author: Debra Patterson, School of Social Work, Wayne State University, 4756 Cass Ave., Detroit, MI 48202, USA. Email: [email protected]
1988
Journal of Interpersonal Violence 30(12)
Studies estimate that only 15% to 41% of all sexual assaults are reported to law enforcement (Bureau of Justice Statistics, 2011; Kilpatrick, Resnick, Ruggiero, Conoscenti, & McCauley, 2007), and of those that are reported, only 14% to 18% are ever prosecuted (see Campbell, 2008; Spohn, 2008, for reviews). When victims/survivors do report, they begin what can be a long, overwhelming process in which they must keep repeating their accounts of the victimization (Martin, 2005). This may deter victims from participating in the criminal justice system (CJS), thus significantly contributing to the likelihood that a case will not be prosecuted (Martin, 2005; Spohn, Beichner, & Davis-Frenzel, 2001). Research has identified multiple barriers to reporting including victims’ self-blame and/or their beliefs that the CJS cannot protect them from their assailants (Allen, 2007; Kilpatrick et al., 2007; Patterson, Greeson, & Campbell, 2009; Ullman, 2010; Wolitzky-Taylor et al., 2011). Victims also may fear that police will not believe them or not treat their cases seriously (Kilpatrick et al., 2007; Konradi, 2007; Patterson & Campbell, 2010). Similarly, victims may worry that participating in the criminal justice (CJ) process (e.g., testifying) will exacerbate their emotional distress (Patterson et al., 2009). Rape crisis center (RCC) advocates may play an important role in addressing and alleviating these barriers, thus facilitating victims’ engagement in the CJS. Advocates often provide services at medical and CJ settings (e.g., police departments) by helping victims navigate these complex systems and by providing crisis intervention (Martin, 2005). Because they often provide services before reporting or early on in the investigation, advocates can address the common concerns that victims have about participating in the CJ process. Despite limited research in this area, preliminary studies have found promising results that advocates may foster victim engagement by helping victims feel more confident about their participation in the CJ process (Campbell, 2006; Patterson & Campbell, 2010). The current study explores how advocates may influence victim engagement by mitigating their barriers to participating in the CJS. Interviews were conducted with 13 advocates and 10 forensic nurses who provide services to victims in a Midwest Sexual Assault Nurse Examiner (SANE) program.
Method Participants The target sample for this study was victim advocates and forensic nurses who provide services to sexual assault survivors in a large Midwestern SANE
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1989
program that is administered by the focal RCC. The RCC has a formal protocol with the local hospitals and police departments to send survivors to the SANE program where advocates routinely provide crisis intervention as well as emotional support during the medical forensic care. Because the nurses often witness advocates’ interactions with survivors, their perspectives were included to triangulate the findings (Patton, 2002). In addition, although the RCC does not have a formal agreement with the police departments to allow advocates to be present during the investigational interviews, most departments allow advocates to accompany survivors. The sample included 10 nurses and 13 advocates (1 forensic nurse did not participate due to scheduling conflicts, yielding a 96% response rate). This is a reasonable sample size for a qualitative study examining a phenomenon in-depth (Creswell, 2007). The participants had an average of 5 years of experience, with a range of 3 months1 to 15 years. The estimated number of survivors served among all of the participants ranged from 3 to 900, with an average of 213 cases. With the exception of the program supervisors, trained volunteers serve as advocates, and the forensic nurses hold contractual employment with the RCC.
Data Collection The first author conducted the in-person interviews that ranged from 31 to 90 min in length, with an average of an hour. With the permission of the participants, the interviews were audio-recorded and transcribed. Field notes identified emerging themes and topics needing further exploration (Creswell, 2007). The procedures used in this study were approved by the Wayne State University Institutional Review Board. The semi-structured interview protocol was informed by the literature on advocacy. In addition, we consulted victim advocates and forensic nurses nationally and revised the interview protocol following those consultations. The overarching project and interview protocol examined many components of advocacy (e.g., impact on survivor well-being). The section of the protocol for the current study examined the participants’ perceptions of how advocates affected survivors’ decisions to report and participate in prosecution. These areas were followed with indepth probing to explore specific components of advocacy services that might influence participation.
Data Analyses Consistent with Strauss and Corbin’s (1990) method of “open coding” and Miles and Huberman’s (1994) concept of “data reduction,” two analysts independently read the transcripts and identified a preliminary list of themes. The
1990
Journal of Interpersonal Violence 30(12)
analysts compared themes, discussed and clarified the meaning of the thematic codes, and revised the coding framework until there was consensus. The transcripts were then independently coded by the two analysts. We used Erickson’s (1986) analytic induction method, which is an iterative procedure for developing and testing empirical assertions in qualitative research. Patton (2002) posits that the “ultimate test” (p. 561) of credibility rests with the primary users of the findings. With this in mind, the findings were shared with five supervisors/directors (two of whom participated in the study) who help oversee the focal program. The directors noted that the findings accurately reflected how advocacy may foster victim engagement with the CJ process.
Results The participants were asked to identify the overarching goals of advocacy to ground the interview. None of the advocates or nurses indicated that they believed the primary goal of advocacy was to persuade victims to participate in the CJ process. Instead, they felt the advocates’ role was to support the decision made by the survivor regarding participating in the CJS. However, participants identified multiple components of advocacy services that might encourage victims to participate in the CJS. There were no differences in themes based on participants’ experience level. Themes were also similar among the advocates and nurses with one exception, which is noted below. First, slightly more than half of the participants indicated that advocates utilized an “empowering” approach with victims that could influence their engagement with the CJS. This approach was described as providing emotional support (e.g., crisis intervention), assessing and addressing their immediate needs, withholding blame and judgment, and offering options to the victim throughout their interactions. Participants explained that this may help survivors feel cared for and like someone is “on their side.” I think if it’s a good experience overall [with the advocate] that they go through that they would, obviously, be more willing to pursue in the criminal system. But if they would come in and it’s this horrible experience, they feel like nobody cares about them, why would they put themselves through all those emotions again, to go testify and do all that stuff . . . I think, that [if] you have that support and someone behind you, and that you would not be alone going through it, I think would make a huge difference. (Nurse 207)
Because a hurtful response by police can be common (Filipas & Ullman, 2001; Monroe et al., 2005), advocates treating survivors with dignity and
Patterson and Tringali
1991
respect may offer them hope that they can endure the CJ process with an ally who cares about their well-being. Second, almost half of the participants (primarily advocates) noted that the information provided by the advocates may reduce victim concerns about the CJS and thus increase their interest in participating. Addressing some common concerns about the CJS may help remove the barriers to victim participation. As one participant noted, “I think us being there helps encourage them to go on.” Advocates can help dispel common myths, particularly those that encourage self-blame. The participants noted that dispelling myths can shift victims’ feelings of anger away from themselves and toward their offenders, which may serve as an impetus to participation in the CJ process: Sometimes that anger can be very productive because that’s when they say, no now I am really mad, no this isn’t going to happen. This isn’t going to happen to somebody else. This did happen to me, and I am really mad about that, and I need to do something about that. (Advocate 101)
Although the primary purpose of reducing self-blame is to promote the victim’s emotional well-being, this intervention may foster the victim’s interest in participating in the CJ process to prevent the offender from assaulting others. Advocates also address safety concerns with the victim, including the option of obtaining a personal protection order (PPO), which is a courtordered injunction that prohibits contact with the complainant (DeJong & Burgess-Proctor, 2006). The participants noted that discussing this option and assisting with the PPO paperwork can ease the victim’s safety concerns. Finally, slightly more than one quarter of the participants suggested that advocates accompanying victims throughout the CJ process would foster victim participation. In these instances, advocates provide emotional support and intervene if they witness maltreatment of the victim. The participants noted that the supportive presence of an advocate can bolster the courage needed for survivors to engage in the CJ process or disclose their assault. There was one case in particular that was not going to go forth. And she [the survivor] had to go back to the police station, and I went with her . . . And because I was there, she was able to tell her story in the way that he [detective] needed to hear it because she had support, because she was being blamed by the police for where she was at the time and the fact that she had been drinking. And when she retold her story with me there she felt able to get it out there, and it did. It got sent to prosecution, because at that point her story, he saw a different side of her story. (Advocate 101)
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Journal of Interpersonal Violence 30(12)
Similarly, other participants noted that the presence of an advocate during the interview also may help victims feel comfortable enough to disclose the assault in detail. This is particularly important because victims may not relay all of the details of the victimization when they feel uncomfortable with law enforcement (Patterson, 2011a). On a similar note, some of the participants also believed that the advocates may influence law enforcement to approach the victim in a positive manner, which can also help the victim continue to participate. For example, one participant described how she confronted an officer whom she believed was being disrespectful toward a victim. The participant said that after the confrontation, the officer began treating the victim with more respect and compassion. Participants observed that when law enforcement treats victims with more respect, it may encourage victim participation.
Discussion In exploring advocate and nurse perceptions about how advocacy services may influence victim engagement with the CJS, this study found multiple components of advocacy that may address common barriers to victim participation. First, research has shown that feelings of guilt and self-blame can be a strong barrier to participation in the CJ process (Starzynski, Ullman, Filipas, & Townsend, 2005; Thompson, Sitterle, Clay, & Kingree, 2007). Our study found that advocates address this by withholding judgment and blame in their interactions with survivors so that they do not contribute to victims’ preexisting feelings of guilt. In addition, advocates in the focal program try to reduce feelings of guilt by dispelling myths that contribute to self-blame. Prior research has shown that helping victims reframe their behaviors as survival- or strength-based can lessen self-blame (Branscombe, Wohl, Owen, Allison, & N’gbala, 2003). This strategy also may help shift the survivors’ anger off themselves and onto the offender, thereby increasing their interest in holding the offender accountable. Second, victims may fear that their perpetrators will retaliate if they participate in the CJ process, which may serve as a strong barrier to participation (Patterson et al., 2009; Ullman, 2010). Fear of revenge is particularly salient for victims of intimate partner rape because a long-standing history of violence or threats may exist. The participants identified that the primary advocacy strategy to reduce this fear was discussing the option of and helping obtain a PPO. The participants believed that survivors were more likely to apply for the protection and subsequently feel safe enough to move forward in the CJ process.
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1993
Third, the extant literature suggests that victims who fear being treated poorly by law enforcement are more reluctant to participate in the CJ process (Kilpatrick et al., 2007; Logan, Evans, Stevenson, & Jordan, 2005). In the current study, participants believed that approaching victims with compassion and respect may offer hope to the victim that they will be treated with respect in subsequent interactions with law enforcement. This finding is consistent with prior research that found victims who experienced respectful treatment by advocates and nurses felt more at ease about participating in the CJ process and anticipated a respectful response by law enforcement (Patterson & Campbell, 2010). Studies have suggested that almost half of the victims who make reports prior to seeking SANE services are treated in a hurtful manner by law enforcement (Filipas & Ullman, 2001; Monroe et al., 2005). In these cases, how might a respectful advocacy approach be useful for survivors who already had a negative experience with law enforcement? The participants explained that this respectful approach may help victims feel like they have at least one professional on “their side,” which may encourage victims to continue participating in the investigational process regardless of an earlier hurtful response by police. Another way to reduce victims’ feelings of vulnerability is for advocates to accompany survivors to their meetings with law enforcement. In addition, prior research suggests that law enforcement treats victims better when advocates are present during the investigational interviews (Campbell, 2006; Patterson, 2011b), which can strengthen the victim’s commitment to participating in prosecution (Konradi, 2007). Accompanying the survivor to the investigational interviews also allows the advocate to intervene if the victim does experience a hurtful response from CJ personnel. When law enforcement treats victims respectfully, the participants noted that victims often feel more comfortable disclosing sensitive details of their assault. This is in line with recent research that found victims were more comfortable disclosing details of their assaults when law enforcement treated them with respect (Patterson, 2011a). Fourth, emerging research has suggested that victims who are concerned about their ability to endure the challenging nature of the CJ process may be more reluctant to participate (Patterson et al., 2009). The participants were less likely to mention strategies to address this barrier, but they did mention that advocates providing information about the CJ process and offering emotional support help increase victims’ confidence about participating in the CJ process. Although the current study provides insight on how advocates may influence victim participation, there are several limitations. The findings of this
1994
Journal of Interpersonal Violence 30(12)
study were from advocates’ and nurses’ perspectives and may not reflect the perceptions of victims or detectives who may not view advocacy as valuable for victim engagement. However, emerging research has found that victims identify advocates as positively influencing their participation in the CJS (Patterson & Campbell, 2010). In addition, adding the police perception would have provided a richer understanding of how advocates impact victim engagement as law enforcement perceptions of advocacy can vary between and even within communities (Sudderth, 2006). The interviews also did not explore whether the advocates’ relationships with law enforcement influenced their ability to help victims engage with the CJS. Research has suggested that the quality of relationships can vary between advocates and police, which might influence advocacy efforts (Sudderth, 2006). Future research can advance the literature by examining how these relationships hinder advocacy efforts to foster victim engagement. Given the qualitative nature of the study, the findings cannot determine whether the advocacy services cause victims to participate in the CJS. Additional research is needed to examine if these advocacy services increase victim participation in the CJ process. The sample also included advocates and nurses from one organization, so the findings may not be generalized to other advocacy service programs. In addition, the retrospective design of the study relies on the memories of participants, who may not have recalled all the strategies used to reduce victims’ barriers to participating in the CJ process. Furthermore, social desirability can play a role in the responses provided by participants. Although the interviewer engaged in multiple strategies to minimize social desirability (e.g., establishing trust through prior research project, emphasizing confidentiality), it is possible that the participants provided responses that overestimate the impact of their services on victim engagement. In spite of these limitations, the findings of this study suggest several implications. Although this exploratory study highlights the role that advocates may play in reducing victim barriers to participation in the CJ process, additional research is needed to understand if these strategies help promote victim participation in the CJS and whether they are effective with more diverse victim populations. In addition, it is important to understand whether victims face other barriers that hamper their participation in the CJS. While advocates may foster victim participation, many victims never seek advocacy services (Campbell, Wasco, Ahrens, Sefl, & Barnes, 2001; Ullman & Filipas, 2001). This may be due to victims being unaware of the services provided by local RCCs (Logan et al., 2005). As such, RCCs may consider utilizing multiple strategies to increase public awareness of their advocacy services, such as social marketing.
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1995
Victims may be more aware of how health care or law enforcement can help following a victimization, and they may be more likely to seek help from these systems rather than from a RCC. However, sometimes these systems do not collaborate with RCCs when providing services to victims. It may be that these professionals lack an understanding of advocacy’s role. Therefore, advocates may need to educate other systems about the value of the services they provide. In conclusion, the non-blaming, empowering care that advocates offer may not only mitigate negative interactions victims experience with law enforcement but may provide these victims with hope and increased confidence in future interactions with the CJS. Further understanding of advocacy’s role in this process may lead to increased inter-system collaboration, which in turn could provide a more comprehensive, victim-centered approach to this pervasive social problem. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
Note 1. All of the participants had more than 1 year of experience with the exception of one advocate who had 3 months of experience. This advocate’s data were based on a few cases of providing advocacy, along with multiple observations of others providing advocacy during her preceptorship. Her interview focused on survivors’ participation during the reporting stage.
References Allen, W. D. (2007). The reporting and underreporting of rape. Southern Economic Journal, 73, 623-641. Branscombe, N. R., Wohl, M. J., Owen, S., Allison, J. A., & N’gbala, A. (2003). Counterfactual thinking, blame assignment, and well-being in rape victims. Basic and Applied Social Psychology, 25, 265-273. Bureau of Justice Statistics. (2011). Criminal victimization, 2010 (NCJ 235508). Washington, DC: U.S. Department of Justice. Retrieved from http://bjs.ojp .usdoj.gov/index.cfm?ty=pbdetail&;iid=2224 Campbell, R. (2006). Rape survivors’ experiences with the legal and medical systems: Do rape victim advocates make a difference? Violence Against Women, 12, 30-45.
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Campbell, R. (2008). The psychological impact of rape victims’ experiences with the legal, medical, and mental health systems. American Psychologist, 63, 702-717. Campbell, R., Wasco, S. M., Ahrens, C. E., Sefl, T., & Barnes, H. E. (2001). Preventing the “second rape.” Journal of Interpersonal Violence, 16, 1239-1259. Creswell, J. W. (2007). Qualitative inquiry and research design. Thousand Oaks, CA: Sage. DeJong, C., & Burgess-Proctor, A. (2006). A summary of personal protection order statutes in the United States. Violence Against Women, 12, 68-88. Erickson, F. (1986). Qualitative methods in research on teaching. In M. C. Wittrock (Ed.), Handbook of research on teaching (3rd ed., pp. 119-161). New York, NY: Macmillan. Filipas, H. H., & Ullman, S. E. (2001). Social reactions to sexual assault victims from various support sources. Violence and Victims, 16, 673-692. Kilpatrick, D. G., Resnick, H. S., Ruggiero, L. M., Conoscenti, M. A., & McCauley, M. S. (2007). Drug-facilitated, incapacitated, and forcible rape: A national study (Final report for grant 2005-WG-BX-0006). Washington, DC: National Institute of Justice. Konradi, A. (2007). Taking the stand. Westport, CT: Praeger. Logan, T., Evans, L., Stevenson, E., & Jordan, C. E. (2005). Barriers to services for rural and urban survivors of rape. Journal of Interpersonal Violence, 20, 591-616. Martin, P. Y. (2005). Rape work. New York, NY: Routledge. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis. Thousand Oaks, CA: Sage. Monroe, L. M., Kinney, L. M., Weist, M. D., Dafeamekpor, D. S., Dantzler, J., & Reynolds, M. W. (2005). The experience of sexual assault. Journal of Interpersonal Violence, 20, 767-777. Patterson, D. (2011a). The impact of detectives’ manner of questioning on rape victims’ disclosure. Violence Against Women, 26, 3618-3639. Patterson, D. (2011b). The linkage between secondary victimization by law enforcement and rape case outcomes. Journal of Interpersonal Violence, 26, 328-437. Patterson, D., & Campbell, R. (2010). Why rape survivors participate in the criminal justice system. Journal of Community Psychology, 38, 191-205. Patterson, D., Greeson, M. R., & Campbell, R. (2009). Understanding rape survivors’ decisions not to seek help from social systems. Health & Social Work, 34, 127-136. Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage. Spohn, C. (2008, June). The criminal justice system’s response to sexual violence. Paper presented at the National Institute of Justice Sexual Violence Research Workshop, Washington, DC. Spohn, C., Beichner, D., & Davis-Frenzel, E. (2001). Prosecutorial justifications for sexual assault case rejection: Guarding the “gateway to justice.” Social Problems, 48, 206-235.
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Starzynski, L. L., Ullman, S. E., Filipas, H. H., & Townsend, S. M. (2005). Correlates of women’s sexual assault disclosure to informal and formal support sources. Violence and Victims, 20, 417-432. Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Thousand Oaks, CA: Sage. Sudderth, L. K. (2006). An uneasy alliance law enforcement and domestic violence victim advocates in a rural area. Feminist Criminology, 1, 329-353. Thompson, M., Sitterle, D., Clay, G., & Kingree, J. (2007). Reasons for not reporting victimizations to the police. Journal of American College Health, 55, 277-282. Ullman, S. E. (2010). Talking about sexual assault: Society’s response to survivors. Washington, DC: American Psychological Association Press. Ullman, S. E., & Filipas, H. H. (2001). Correlates of formal and informal support seeking in sexual assault victims. Journal of Interpersonal Violence, 16, 1028-1047. Wolitzky-Taylor, K. B., Resnick, H. S., McCauley, J. L., Amstadter, A. B., Kilpatrick, D. G., & Ruggiero, K. J. (2011). Is reporting of rape on the rise? A comparison of women with reported versus unreported rape experiences in the national women’s study-replication. Journal of Interpersonal Violence, 26, 807-832.
Author Biographies Debra Patterson, PhD, is an associate professor in the School of Social Work at Wayne State University. Her research examines sexual assault victims/survivors’ barriers to help-seeking; formal social systems’ responses to sexual assault survivors; and community collaborative efforts in improving the response to sexual assault survivors. She has been working in the violence against women field for 18 years. Brenda Tringali, MSW, is a graduate of the School of Social Work at Wayne State University. Her interests include interpersonal practice, as well as interventions to improve formal social systems.
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JIVXXX10.1177/0886260514552273Journal of Interpersonal ViolencePatterson and Tringali
Article
Understanding How Advocates Can Affect Sexual Assault Victim Engagement in the Criminal Justice Process
Journal of Interpersonal Violence 2015, Vol. 30(12) 1987–1997 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260514552273 jiv.sagepub.com
Debra Patterson, PhD1 and Brenda Tringali, MSW1
Abstract Following a sexual assault, survivors may seek help from multiple community organizations including the criminal justice system (CJS). However, sexual assault survivors often feel apprehensive about participating in the CJS and thus, few report their victimizations to law enforcement. Of those who report, many withdraw their participation from the CJS. Rape crisis center advocates often are one of the first professionals victims encounter while seeking help after a victimization and thus, they may play a key role in reducing barriers to victim participation in the CJS. Qualitative interviews were conducted with forensic nurses and victim advocates at a Midwest Sexual Assault Nurse Examiner (SANE) program to examine how advocacy services may influence victim engagement with the CJS. This study found multiple components of advocacy services that may address common barriers to victim participation. Implications for research and practice are discussed. Keywords sexual assault, rape, victim advocates, criminal justice, Sexual Assault Nurse Examiner programs 1Wayne
State University, Detroit, MI, USA
Corresponding Author: Debra Patterson, School of Social Work, Wayne State University, 4756 Cass Ave., Detroit, MI 48202, USA. Email: [email protected]
1988
Journal of Interpersonal Violence 30(12)
Studies estimate that only 15% to 41% of all sexual assaults are reported to law enforcement (Bureau of Justice Statistics, 2011; Kilpatrick, Resnick, Ruggiero, Conoscenti, & McCauley, 2007), and of those that are reported, only 14% to 18% are ever prosecuted (see Campbell, 2008; Spohn, 2008, for reviews). When victims/survivors do report, they begin what can be a long, overwhelming process in which they must keep repeating their accounts of the victimization (Martin, 2005). This may deter victims from participating in the criminal justice system (CJS), thus significantly contributing to the likelihood that a case will not be prosecuted (Martin, 2005; Spohn, Beichner, & Davis-Frenzel, 2001). Research has identified multiple barriers to reporting including victims’ self-blame and/or their beliefs that the CJS cannot protect them from their assailants (Allen, 2007; Kilpatrick et al., 2007; Patterson, Greeson, & Campbell, 2009; Ullman, 2010; Wolitzky-Taylor et al., 2011). Victims also may fear that police will not believe them or not treat their cases seriously (Kilpatrick et al., 2007; Konradi, 2007; Patterson & Campbell, 2010). Similarly, victims may worry that participating in the criminal justice (CJ) process (e.g., testifying) will exacerbate their emotional distress (Patterson et al., 2009). Rape crisis center (RCC) advocates may play an important role in addressing and alleviating these barriers, thus facilitating victims’ engagement in the CJS. Advocates often provide services at medical and CJ settings (e.g., police departments) by helping victims navigate these complex systems and by providing crisis intervention (Martin, 2005). Because they often provide services before reporting or early on in the investigation, advocates can address the common concerns that victims have about participating in the CJ process. Despite limited research in this area, preliminary studies have found promising results that advocates may foster victim engagement by helping victims feel more confident about their participation in the CJ process (Campbell, 2006; Patterson & Campbell, 2010). The current study explores how advocates may influence victim engagement by mitigating their barriers to participating in the CJS. Interviews were conducted with 13 advocates and 10 forensic nurses who provide services to victims in a Midwest Sexual Assault Nurse Examiner (SANE) program.
Method Participants The target sample for this study was victim advocates and forensic nurses who provide services to sexual assault survivors in a large Midwestern SANE
Patterson and Tringali
1989
program that is administered by the focal RCC. The RCC has a formal protocol with the local hospitals and police departments to send survivors to the SANE program where advocates routinely provide crisis intervention as well as emotional support during the medical forensic care. Because the nurses often witness advocates’ interactions with survivors, their perspectives were included to triangulate the findings (Patton, 2002). In addition, although the RCC does not have a formal agreement with the police departments to allow advocates to be present during the investigational interviews, most departments allow advocates to accompany survivors. The sample included 10 nurses and 13 advocates (1 forensic nurse did not participate due to scheduling conflicts, yielding a 96% response rate). This is a reasonable sample size for a qualitative study examining a phenomenon in-depth (Creswell, 2007). The participants had an average of 5 years of experience, with a range of 3 months1 to 15 years. The estimated number of survivors served among all of the participants ranged from 3 to 900, with an average of 213 cases. With the exception of the program supervisors, trained volunteers serve as advocates, and the forensic nurses hold contractual employment with the RCC.
Data Collection The first author conducted the in-person interviews that ranged from 31 to 90 min in length, with an average of an hour. With the permission of the participants, the interviews were audio-recorded and transcribed. Field notes identified emerging themes and topics needing further exploration (Creswell, 2007). The procedures used in this study were approved by the Wayne State University Institutional Review Board. The semi-structured interview protocol was informed by the literature on advocacy. In addition, we consulted victim advocates and forensic nurses nationally and revised the interview protocol following those consultations. The overarching project and interview protocol examined many components of advocacy (e.g., impact on survivor well-being). The section of the protocol for the current study examined the participants’ perceptions of how advocates affected survivors’ decisions to report and participate in prosecution. These areas were followed with indepth probing to explore specific components of advocacy services that might influence participation.
Data Analyses Consistent with Strauss and Corbin’s (1990) method of “open coding” and Miles and Huberman’s (1994) concept of “data reduction,” two analysts independently read the transcripts and identified a preliminary list of themes. The
1990
Journal of Interpersonal Violence 30(12)
analysts compared themes, discussed and clarified the meaning of the thematic codes, and revised the coding framework until there was consensus. The transcripts were then independently coded by the two analysts. We used Erickson’s (1986) analytic induction method, which is an iterative procedure for developing and testing empirical assertions in qualitative research. Patton (2002) posits that the “ultimate test” (p. 561) of credibility rests with the primary users of the findings. With this in mind, the findings were shared with five supervisors/directors (two of whom participated in the study) who help oversee the focal program. The directors noted that the findings accurately reflected how advocacy may foster victim engagement with the CJ process.
Results The participants were asked to identify the overarching goals of advocacy to ground the interview. None of the advocates or nurses indicated that they believed the primary goal of advocacy was to persuade victims to participate in the CJ process. Instead, they felt the advocates’ role was to support the decision made by the survivor regarding participating in the CJS. However, participants identified multiple components of advocacy services that might encourage victims to participate in the CJS. There were no differences in themes based on participants’ experience level. Themes were also similar among the advocates and nurses with one exception, which is noted below. First, slightly more than half of the participants indicated that advocates utilized an “empowering” approach with victims that could influence their engagement with the CJS. This approach was described as providing emotional support (e.g., crisis intervention), assessing and addressing their immediate needs, withholding blame and judgment, and offering options to the victim throughout their interactions. Participants explained that this may help survivors feel cared for and like someone is “on their side.” I think if it’s a good experience overall [with the advocate] that they go through that they would, obviously, be more willing to pursue in the criminal system. But if they would come in and it’s this horrible experience, they feel like nobody cares about them, why would they put themselves through all those emotions again, to go testify and do all that stuff . . . I think, that [if] you have that support and someone behind you, and that you would not be alone going through it, I think would make a huge difference. (Nurse 207)
Because a hurtful response by police can be common (Filipas & Ullman, 2001; Monroe et al., 2005), advocates treating survivors with dignity and
Patterson and Tringali
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respect may offer them hope that they can endure the CJ process with an ally who cares about their well-being. Second, almost half of the participants (primarily advocates) noted that the information provided by the advocates may reduce victim concerns about the CJS and thus increase their interest in participating. Addressing some common concerns about the CJS may help remove the barriers to victim participation. As one participant noted, “I think us being there helps encourage them to go on.” Advocates can help dispel common myths, particularly those that encourage self-blame. The participants noted that dispelling myths can shift victims’ feelings of anger away from themselves and toward their offenders, which may serve as an impetus to participation in the CJ process: Sometimes that anger can be very productive because that’s when they say, no now I am really mad, no this isn’t going to happen. This isn’t going to happen to somebody else. This did happen to me, and I am really mad about that, and I need to do something about that. (Advocate 101)
Although the primary purpose of reducing self-blame is to promote the victim’s emotional well-being, this intervention may foster the victim’s interest in participating in the CJ process to prevent the offender from assaulting others. Advocates also address safety concerns with the victim, including the option of obtaining a personal protection order (PPO), which is a courtordered injunction that prohibits contact with the complainant (DeJong & Burgess-Proctor, 2006). The participants noted that discussing this option and assisting with the PPO paperwork can ease the victim’s safety concerns. Finally, slightly more than one quarter of the participants suggested that advocates accompanying victims throughout the CJ process would foster victim participation. In these instances, advocates provide emotional support and intervene if they witness maltreatment of the victim. The participants noted that the supportive presence of an advocate can bolster the courage needed for survivors to engage in the CJ process or disclose their assault. There was one case in particular that was not going to go forth. And she [the survivor] had to go back to the police station, and I went with her . . . And because I was there, she was able to tell her story in the way that he [detective] needed to hear it because she had support, because she was being blamed by the police for where she was at the time and the fact that she had been drinking. And when she retold her story with me there she felt able to get it out there, and it did. It got sent to prosecution, because at that point her story, he saw a different side of her story. (Advocate 101)
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Similarly, other participants noted that the presence of an advocate during the interview also may help victims feel comfortable enough to disclose the assault in detail. This is particularly important because victims may not relay all of the details of the victimization when they feel uncomfortable with law enforcement (Patterson, 2011a). On a similar note, some of the participants also believed that the advocates may influence law enforcement to approach the victim in a positive manner, which can also help the victim continue to participate. For example, one participant described how she confronted an officer whom she believed was being disrespectful toward a victim. The participant said that after the confrontation, the officer began treating the victim with more respect and compassion. Participants observed that when law enforcement treats victims with more respect, it may encourage victim participation.
Discussion In exploring advocate and nurse perceptions about how advocacy services may influence victim engagement with the CJS, this study found multiple components of advocacy that may address common barriers to victim participation. First, research has shown that feelings of guilt and self-blame can be a strong barrier to participation in the CJ process (Starzynski, Ullman, Filipas, & Townsend, 2005; Thompson, Sitterle, Clay, & Kingree, 2007). Our study found that advocates address this by withholding judgment and blame in their interactions with survivors so that they do not contribute to victims’ preexisting feelings of guilt. In addition, advocates in the focal program try to reduce feelings of guilt by dispelling myths that contribute to self-blame. Prior research has shown that helping victims reframe their behaviors as survival- or strength-based can lessen self-blame (Branscombe, Wohl, Owen, Allison, & N’gbala, 2003). This strategy also may help shift the survivors’ anger off themselves and onto the offender, thereby increasing their interest in holding the offender accountable. Second, victims may fear that their perpetrators will retaliate if they participate in the CJ process, which may serve as a strong barrier to participation (Patterson et al., 2009; Ullman, 2010). Fear of revenge is particularly salient for victims of intimate partner rape because a long-standing history of violence or threats may exist. The participants identified that the primary advocacy strategy to reduce this fear was discussing the option of and helping obtain a PPO. The participants believed that survivors were more likely to apply for the protection and subsequently feel safe enough to move forward in the CJ process.
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Third, the extant literature suggests that victims who fear being treated poorly by law enforcement are more reluctant to participate in the CJ process (Kilpatrick et al., 2007; Logan, Evans, Stevenson, & Jordan, 2005). In the current study, participants believed that approaching victims with compassion and respect may offer hope to the victim that they will be treated with respect in subsequent interactions with law enforcement. This finding is consistent with prior research that found victims who experienced respectful treatment by advocates and nurses felt more at ease about participating in the CJ process and anticipated a respectful response by law enforcement (Patterson & Campbell, 2010). Studies have suggested that almost half of the victims who make reports prior to seeking SANE services are treated in a hurtful manner by law enforcement (Filipas & Ullman, 2001; Monroe et al., 2005). In these cases, how might a respectful advocacy approach be useful for survivors who already had a negative experience with law enforcement? The participants explained that this respectful approach may help victims feel like they have at least one professional on “their side,” which may encourage victims to continue participating in the investigational process regardless of an earlier hurtful response by police. Another way to reduce victims’ feelings of vulnerability is for advocates to accompany survivors to their meetings with law enforcement. In addition, prior research suggests that law enforcement treats victims better when advocates are present during the investigational interviews (Campbell, 2006; Patterson, 2011b), which can strengthen the victim’s commitment to participating in prosecution (Konradi, 2007). Accompanying the survivor to the investigational interviews also allows the advocate to intervene if the victim does experience a hurtful response from CJ personnel. When law enforcement treats victims respectfully, the participants noted that victims often feel more comfortable disclosing sensitive details of their assault. This is in line with recent research that found victims were more comfortable disclosing details of their assaults when law enforcement treated them with respect (Patterson, 2011a). Fourth, emerging research has suggested that victims who are concerned about their ability to endure the challenging nature of the CJ process may be more reluctant to participate (Patterson et al., 2009). The participants were less likely to mention strategies to address this barrier, but they did mention that advocates providing information about the CJ process and offering emotional support help increase victims’ confidence about participating in the CJ process. Although the current study provides insight on how advocates may influence victim participation, there are several limitations. The findings of this
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study were from advocates’ and nurses’ perspectives and may not reflect the perceptions of victims or detectives who may not view advocacy as valuable for victim engagement. However, emerging research has found that victims identify advocates as positively influencing their participation in the CJS (Patterson & Campbell, 2010). In addition, adding the police perception would have provided a richer understanding of how advocates impact victim engagement as law enforcement perceptions of advocacy can vary between and even within communities (Sudderth, 2006). The interviews also did not explore whether the advocates’ relationships with law enforcement influenced their ability to help victims engage with the CJS. Research has suggested that the quality of relationships can vary between advocates and police, which might influence advocacy efforts (Sudderth, 2006). Future research can advance the literature by examining how these relationships hinder advocacy efforts to foster victim engagement. Given the qualitative nature of the study, the findings cannot determine whether the advocacy services cause victims to participate in the CJS. Additional research is needed to examine if these advocacy services increase victim participation in the CJ process. The sample also included advocates and nurses from one organization, so the findings may not be generalized to other advocacy service programs. In addition, the retrospective design of the study relies on the memories of participants, who may not have recalled all the strategies used to reduce victims’ barriers to participating in the CJ process. Furthermore, social desirability can play a role in the responses provided by participants. Although the interviewer engaged in multiple strategies to minimize social desirability (e.g., establishing trust through prior research project, emphasizing confidentiality), it is possible that the participants provided responses that overestimate the impact of their services on victim engagement. In spite of these limitations, the findings of this study suggest several implications. Although this exploratory study highlights the role that advocates may play in reducing victim barriers to participation in the CJ process, additional research is needed to understand if these strategies help promote victim participation in the CJS and whether they are effective with more diverse victim populations. In addition, it is important to understand whether victims face other barriers that hamper their participation in the CJS. While advocates may foster victim participation, many victims never seek advocacy services (Campbell, Wasco, Ahrens, Sefl, & Barnes, 2001; Ullman & Filipas, 2001). This may be due to victims being unaware of the services provided by local RCCs (Logan et al., 2005). As such, RCCs may consider utilizing multiple strategies to increase public awareness of their advocacy services, such as social marketing.
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Victims may be more aware of how health care or law enforcement can help following a victimization, and they may be more likely to seek help from these systems rather than from a RCC. However, sometimes these systems do not collaborate with RCCs when providing services to victims. It may be that these professionals lack an understanding of advocacy’s role. Therefore, advocates may need to educate other systems about the value of the services they provide. In conclusion, the non-blaming, empowering care that advocates offer may not only mitigate negative interactions victims experience with law enforcement but may provide these victims with hope and increased confidence in future interactions with the CJS. Further understanding of advocacy’s role in this process may lead to increased inter-system collaboration, which in turn could provide a more comprehensive, victim-centered approach to this pervasive social problem. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
Note 1. All of the participants had more than 1 year of experience with the exception of one advocate who had 3 months of experience. This advocate’s data were based on a few cases of providing advocacy, along with multiple observations of others providing advocacy during her preceptorship. Her interview focused on survivors’ participation during the reporting stage.
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Author Biographies Debra Patterson, PhD, is an associate professor in the School of Social Work at Wayne State University. Her research examines sexual assault victims/survivors’ barriers to help-seeking; formal social systems’ responses to sexual assault survivors; and community collaborative efforts in improving the response to sexual assault survivors. She has been working in the violence against women field for 18 years. Brenda Tringali, MSW, is a graduate of the School of Social Work at Wayne State University. Her interests include interpersonal practice, as well as interventions to improve formal social systems.
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